2020-2021 Early Childhood Court Evaluation

EXECUTIVE SUMMARY

Background SEPTEMBER 15, 2021 Principal Investigator: Lisa Magruder, Ph.D., MSW, Florida Institute for Child Welfare Co-Principal Investigator: Jennifer Marshall, Ph.D., MPH, University of South Florida Florida Institute for Child Welfare Research Team: Lisa Magruder, Ph.D., MSW Michael Killian, Ph.D., MSW Colleen McBride, M.A. Taylor Dowdy-Hazlett, MSW Michae’ Cain, MSW University of South Florida Research Team: Jennifer Marshall, Ph.D., MPH Laura Kihlström, Ph.D., MS, MPH Joanna Mackie, Ph.D., MPP Tara Foti, Ph.D., MPH Shanda Vereen, MSPH Caitlnn Carr, M.A. Megan Bell, MPH Expert Consultants: Kimberly Renk, Ph.D., IMH-E® Diane Koch, Ph.D., IMH-E® Meredith Piazza, LCSW

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Introduction Per Florida Statute 39.01304 (2) (2020),1 “the Office of the State Courts Administrator [OSCA] shall contract for an evaluation of the early childhood court programs to ensure the quality, accountability, and fidelity of the programs’ evidence-based treatment.” ZERO TO THREE (ZTT) contracted with the Florida Institute for Child Welfare (hereinafter, Institute) to develop and execute an evaluation plan to address this statute. The Institute, in consultation with ZTT and OSCA’s Office of Court Improvement (OCI), determined that the priority was evaluating the effectiveness of therapeutic modalities related to parenting and the parent-child relationship. To address the evaluation priorities, the Institute conducted two distinct but related evaluation initiatives: 1) a mixed-methods evaluation of the effectiveness of therapeutic modalities, and 2) a qualitative exploration of the perspectives of ECC-involved caregivers and providers regarding the therapeutic services and benefits of Early Childhood Court.

EARLY CHILDHOOD COURT Early Childhood Court, based on the Safe Babies Court Team approach, works to address child welfare cases involving children under the age of five who have been placed in out-of-home care. The goal of ECC is to improve child well-being, address trauma, repair family relationships, and promote permanency.2 Core components of ECC include: judicial and child welfare leadership, a local community coordinator, an active community team, family team meetings, a continuum of services, meeting parents where they are, enhancing parents’ relationships and social supports, frequent visitation, individualized concurrent case planning, and systemic quality improvement.3 ECC emphasizes a collaborative approach. Each case joins a team of parents, caregivers, a judge, a community coordinator, an infant mental health specialist, attorneys, a guardian ad litem, and a child welfare case manager. These “family teams” meet monthly to discuss the family’s progress and recommend changes to the case plan as needed.4 ECC was first adopted as a model in 2005,5 and has since been implemented in 99 sites across 30 states.6 Florida’s ECC launched in 2014 and is currently active in 27 sites statewide.2 Between 2015 and 2020, Florida’s ECC closed 577 cases involving children between the ages of 0 and 5 years.7 While ECC-involved children achieve reunification at the same rate as non-ECC children, the time to reunification is approximately 8.5 months shorter for those whose cases are addressed within ECC. In addition, the adoption rate of ECC-involved children is much higher than that of non-ECC children, while the rate of children placed in permanent guardianship is lower.2 Several studies have found that permanency is achieved sooner for ECC-involved children than non-ECC-involved children.2,8,9 There is also evidence that ECCinvolved children have improved developmental and behavioral outcomes.10,11 PARENTING INTERVENTIONS IN EARLY CHILDHOOD COURT Circle of Security-Parenting (COS-P) Circle of Security (COS) is a parenting program guided by Bowlby’s attachment theory, which teaches parents how to be a secure base for their children by responding sensitively to their needs.12 Adapted from COS-Intensive, COS-P is a manualized program that utilizes videos to assist caregivers to understand attachment and reflect on how their feelings and relationship history impacts their parenting practices. COS-P aims to reduce insecure and disorganized attachment and increase parenting sensitivity. COS-P consists of eight chapters, each chapter consisting of one 15-minute video showing parent-child interactions and previous participants’ feelings about what they learned in the intervention. Required training for providers includes a 4-day training and coaching after training completion.13 COS-P offers optional fidelity coaching which begins at the start of COS-P training and runs in conjunction with a reflective journal requirement. COS-P has demonstrated promising outcomes, such as decreasing unresponsive behaviors in mothers;14 and stress, depression, and anxiety symptoms.15

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Child-Parent Psychotherapy (CPP) Rooted in infant-parent psychotherapy, child-parent psychotherapy (CPP) emerged as a therapeutic modality in the mid-1990s.16 CPP is used to treat children ages 0-5 years who experienced traumatic events (e.g., separation from a caregiver, violence or abuse, or the death of a loved one).17 Primarily based in attachment theory, CPP aims to strengthen the relationship between children and caregivers and help families appropriately process and respond to trauma.18 Providers engage in an intensive 18-month training, that costs up to $2,500 per participant.19,20,21,22 CPP occurs in three phases: the foundational phase, the core intervention phase, and the termination phase.23 CPP is intended to be carried out over 52 weekly sessions lasting 1 to 1.5 hours which may take place in the family’s home, the provider’s office, or in a school or daycare setting.24 Researchers developed six strands of CPP fidelity designed to help the provider understand their own adherence to CPP: content, procedure, reflective practice, emotional process, dyadic relational, and trauma framework; each phase has an accompanying fidelity form.25 The CEBC indicates that CPP is “supported by evidence-based research.”24 Several randomized controlled trials have found that CPP is effective for both children and their caregivers. For example, infants who experienced abuse or neglect had higher levels of secure attachment after being treated with CPP; a follow-up study demonstrated that these effects were sustained for at least one year.24,26,27

Methodology and Findings

INITIATIVE ONE: A MIXED-METHODS EVALUATION OF THE EFFECTIVENESS OF THERAPEUTIC MODALITIES Initiative one included interviews with therapeutic providers (N = 13), surveys with therapeutic providers (N = 6), and secondary data analysis of CPP outcomes (N = 805). Interviews Evaluators invited 52 clinicians, identified by their community coordinator as a provider of ECC parenting therapies, to participate in an interview. Thirteen clinicians, representing disparate areas of Florida, completed an approximately one-hour interview and received a $25 Amazon.com gift card in recognition of their time. Interviews explored clinicians’ primary modalities, their interactions with families and the parent-child dyad, and their experience as ECC team members. Evaluators applied thematic analysis to the interview data.28,29,30 Clinicians represented diverse educational and therapeutic training backgrounds, though many reported a history of work within the child welfare system. There was also varied tenure within their ECC teams, as well as how consistently they work with ECC-involved families. While some providers have been a part of their ECC team since or near inception, many reported being onboarded through their employer, often without adequate orientation to ECC and the team. While clinicians noted their appreciation for the intensive team approach—including benefits for clients as well as team members— they identified numerous challenges such as a lack of understanding of roles. Clinicians reported that their primary function on the team, in addition to direct work with families, is to provide family progress updates or reports at family team meetings and court hearings. Some shared it can be difficult to articulate their perspectives on cases given their typical complexity. For example, some felt that their fellow teammates did not understand therapeutic participation is not a simple checkbox and that parents’ implementation of skills is necessary. Providers also reported feeling pressured to be the team member responsible for initiating difficult conversations about clients (e.g., bringing up “the elephant in the room”).

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In terms of service provision, clinicians shared that their ECCinvolved clients represent diverse demographics, though did note some common characteristics and referral reasons (e.g., substance use, domestic violence, mental health). Working with families can be challenging given systemic barriers (e.g., transportation, poverty) as well as client factors (e.g., lack of engagement, struggles with sobriety). Providers shared that sometimes it seems like the system is setting up families for failure, especially for parents with substance abuse issues. Still, providers report witnessing “beautiful moments” in their work with families and generally reiterated their appreciation for the ECC model. In general, participants in the present sample described the COS-P essential elements very similarly to its intended structure and goals. They spoke to the short training;13 the usual group nature of the work, with optional individual work;31 the series of eight videos and subsequent reflection activities;14 and the goal of educating parents on attachment and improving their responses to children’s cues.12 Most participants in the sample discussed their use of CPP and, similar to COS-P implementation, there is initial evidence of broad fidelity to the model. Participants described CPP as being rooted in concepts of attachment and trauma18 and discussed the three major phases of treatment (i.e., foundation, core, termination).23 The core, or “intervention” phase, was noted as largely reliant on play-based work.23 While providers spoke about fidelity generally, their stories alluded to multiple fidelity strands, such as reflective practice, dyadic/relational, and trauma framework.25 Overall, without assessing specific points of fidelity, present findings indicate that providers are implementing CPP in alignment with its essential tenets, corroborating previous findings.32,33 Surveys As a follow-up to the qualitative interviews, evaluators invited 44 clinicians to participate in a survey to assess their general fidelity to the therapeutic approaches. Survey items were primarily informed by the qualitative findings, expert consultation, and modality protocols. Qualitative findings indicated providers primarily use COS-P and CPP, often in conjunction with one another. Therefore, evaluators relied on a single survey to capture the use of one or both of the modalities, including nuanced closed- and open-ended items regarding implementation. The same sampling frame as the interviews was utilized, with adjustments made for those no longer providing services or otherwise unreachable. The final sample size included 6 clinicians (13.63% response rate). Importantly, only three providers completed the survey in its entirety. No incentive was offered for completion of the survey. The research team used SPSS to run frequencies and descriptive statistics as appropriate. Given the very small sample size, the researchers did not run inferential statistics. All providers held graduate degrees and received prescribed training in their respective modalities. Similar to findings from qualitative interviews with providers, there was variation in both process of and satisfaction with orientation to the ECC model. In general, COS-P providers indicated fidelity to the model by viewing and debriefing the eight-video series with clients, helping them connect the material to their own parenting practices. Practices were described more similarly for COS-P, likely given its semi-structured approach. CPP providers were more varied in their approach with families, including service delivery setting, duration of treatment, use of assessment tools, and specific therapeutic techniques. This is congruent with the findings from qualitative interviews with providers, where CPP was described as a “framework” as opposed to a structured modality. That is, the primary focus remains on building parent-child attachments through a trauma-informed approach, though the nuance of session content and delivery is highly dependent on the needs of individual families. Despite this variation, CPP providers self-reported

procedural fidelity with respect to certain foundational, core, and termination phase activities.23 Assessments used throughout CPP varied, though the CPP fidelity forms are not prescriptive in terms of required tools. For example, during the foundational phase, the TESI-PRR is specifically offered as an instrument to screen for child trauma history, though only one provider in the current sample indicated using this. However, there is an option on the fidelity form to indicate a different instrument’s use. Finally, reflective supervision among this small sample suggests it is a supportive mechanism toward clinician wellbeing and skill-building. Findings are limited by a very small sample size, though do supplement previous qualitative data toward better understanding how therapeutic modalities are being implemented with ECC-involved families. Secondary Data Analysis To complement the provider data, the evaluation team conducted secondary data analyses of administrative data to assess outcomes by treatment modality. Availability of data were limited in that variables related to therapeutic modality are only standardly collected for CPP; there are no standardly collected variables on COS-P or other parenting or parent-child relationship variables. Therefore, analysis of administrative data focused on CPP. Importantly, there were significant missing data; results should be interpreted conservatively. The OCI, based on available administrative data and consultation with the evaluation team, provided de-identified data for all closed ECC cases between 2014 and 2020 (N = 805). Given that all cases were closed, all were eligible for inclusion in analyses regarding families’ CPP involvement (yes/no). In addition to CPP involvement, variables included demographics, case details (e.g., reasons for referral, substance use), and outcomes (i.e., re-removal, time to permanency, permanency type). Analyses tested for differences between those ECC-involved families receiving and not receiving CPP (hereinafter, CPP and standard services, respectively). Statistical analyses testing for differences between these groups of parents included chi-square (χ2) and independent samples t-tests. Few differences emerged between families that received CPP services compared to services as usual. The proportion of families referred to services for domestic or family violence or failure to thrive was higher in CPP-involved families, while proportionally more families with illicit substance use received standard services. In terms of outcomes, a significantly greater proportion of CPPinvolved families achieved reunification with one or both parents compared to those not involved in CPP. No differences existed between the groups for re-removals or an outcome of TPR. Although time to reunification did not differ between groups, time to case closure was significantly longer for those in the CPP group. Notably, there was significant missing data for parent and child assessments. The present analyses are limited by data availability and inconsistencies in reporting. Regarding data availability, treatment details (e.g., completion of services, assessment scores) are optional fields in the OCI’s data management system (Leigh Merritt, personal communication, March 11, 2021); thus, some cases had missing data on these variables. The greatest frequency of missing data was observed in assessment scores for both children and parents, nearing 100 percent for parental assessments. Standardly collected pre- and post-treatment assessment scores would be useful in better assessing family progress in therapeutic treatment as well as case outcomes. For example, assessment scores could be used in predictive modeling of permanency type. Inconsistencies were also noted. For example, while some cases were coded as having received CPP services, their corresponding number of CPP sessions at exit were listed as zero. In some—but not all— instances, this appeared to be due to the TPR status of the case.

INITIATIVE TWO: A QUALITATIVE EXPLORATION OF THE PERSPECTIVES OF ECC-INVOLVED CAREGIVERS AND PROVIDERS REGARDING THE THERAPEUTIC SERVICES AND BENEFITS OF EARLY CHILDHOOD COURT Initiative two included interviews with caregivers, parents, and providers. To be eligible, participants had to be part of a team that surrounds a child enrolled in Florida ECC between 2019 and 2021 (current or closed cases). Recruitment for the evaluation was conducted via email. Invitation flyers with the evaluation team contact information were distributed to potential participants through the ECC network (parents, foster parents, community coordinators, therapists etc.). Parents and caregivers were recruited first. Participants interested in completing an interview contacted the evaluation team via email or phone to schedule an interview. Once parents and caregivers were interviewed, they were asked to refer the name of providers and individuals in their care network that played a therapeutic role in their ECC experience. If the specific provider/individual’s name was given, those individuals/providers were then contacted via email and/or phone and asked if they would like to participate in an interview. If the parent/caregiver only named a role or agency, contact information was requested from the community coordinator. Furthermore, the names of the participants who referred the providers were not disclosed to providers; therefore, named individuals within roles were not directly connected with interviewed parents/caregivers and some providers worked with more than one of the interviewed parents/caregivers. A total of 16 participants (6 biological parents, two foster parents, 8 providers) were included in the evaluation. Providers included in this evaluation represented multiple roles and positions within ECC, including community coordinator, substance abuse case manager, assistant regional counsel, child advocate/guardian ad litem, judge, psychotherapist, and domestic violence counselor. Interviews were completed with participants over the phone and followed a semi-structured interview guide focusing on the themes of therapeutic programs, approaches, methods, and strategies used within Florida ECCs; caregiver and team member relationships in ECC; improvements for ECC therapeutic services and relationships; as well as considerations of racial and social equity. While recruitment was statewide, participants responded from two counties within one court circuit. Participants received a $25 electronic gift card following the interview. After completing the initial interview, participants received follow-up questions in the form of a short survey to gather demographic information such as age, gender identity, and education. Interviews were transcribed verbatim and reviewed by the evaluation team for accuracy. Data analysis was conducted for parent/caregiver and provider interviews separately, with two research team members coding provider interview transcripts and two team members coding parent/ caregiver interview transcripts. All data analysis was completed with MAXQDA and using a thematic analysis approach.29 When asked to describe their overall experience within the Early Childhood Court (ECC) system, most of the parents/caregivers responded with positive appraisals, stating that their experience was “a blessing,” “positive,” or “a good experience.” A small number of parents reported that their experiences in ECC were very different from what they expected because they previously heard negative comments about dealing with the court system in general. These participants felt that the negative appraisals were due to individuals not wanting to do the work required to resolve their case. There were several commonalities among parent/caregivers’ descriptions of the individuals who helped them most or were supportive of their well-being from a therapeutic standpoint (Figure 1).

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Figure 1. Roles of the individuals mentioned by participants as supportive during their ECC experience

While the focus of ECC and the child welfare system is the safety and wellbeing of the child, ECC places emphasis on therapeutic components that support the parent’s mental health and parenting approaches, and the parent-child relationship. The results of our evaluation of parent-reported therapeutic networks were telling, illustrating those ECC and non-ECC members who play a critical role in parents’ and caregivers’ therapeutic processes. The therapeutic network and influences include the important role of the therapist but also extend to the community coordinator, intimate partner violence and substance use disorder providers, and also family members. As the most mentioned person in the therapeutic network, the community coordinator was seen as particularly essential to the parent/caregiver therapeutic network. They play a role in creating a welcoming and supportive environment for the parent/caregiver and serve as a connection between the providers in the therapeutic network as well. In addition, therapeutic networks often include other family members and/or caregivers, counselors from intimate partner violence and substance treatment programs, as well as child-parent psychotherapists. The interviews highlight the importance of understanding the complexities of providing services for individuals experiencing multiple traumas. Trauma-informed care was mentioned by both providers and parents/caregivers as a crucial component of the therapeutic process in ECC. Other stressors like substance use, violence, socioeconomic situation, and life circumstances, along with having the child removed, compound past traumas that can be triggered by the ECC experience—that should be recognized, acknowledged, and addressed. Substance use emerged as a significant theme for ECC program participants in the context of the trauma-related evaluation question. Parents formerly or currently experiencing substance dependence referenced the need for providers/ECC staff members to gain further training on substance dependence and recovery, suggesting that all ECC team members should receive training on what substance use is like for those experiencing it (empathy), as well as increased education on addiction in general. Overall, our findings suggest that parents involved in ECC value the therapeutic approaches offered. In addition, parents noted that qualities such as encouragement, genuineness, empathy, and

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reassurance are essential for ECC team members when working directly with parents and caregivers. Parents conveyed that in order to feel part of a team that has their child’s best interests in mind, they need to feel like the ECC team is “speaking up for them” when misunderstandings, misrepresentation, or bureaucratic issues occur within the broader child welfare system. While parents did not articulate that ECC was discriminatory, it was noted that some individuals in the system—particularly DCF—were less respectful, reliable, and supportive than others. These factors play a significant role in whether or not the parent/caregiver truly engaged in the program and essential therapeutic processes and influenced the parent/caregivers’ overall well-being. While efforts were made to recruit participants across the state of Florida, the evaluation findings are reported for one court circuit across two counties. Even with full support of circuit court judges, OCI, and the ECC state lead who facilitated reminders to staff throughout the state (we were unable to contact parents directly), participant recruitment was challenging. While in-person recruitment may have been preferred, potential participants and those helping with recruitment were contacted primarily through email due to the constraints of the ongoing COVID-19 pandemic. Despite limitations, the results of this evaluation help us understand the complexities of the parent and caregiver experience in ECC.

Summary and Evaluation of Findings Most clinicians report using CPP and COS- P in their therapeutic work with parents. Clinicians expressed a need to be client responsive as opposed to following rigid protocols, but still work toward procedural fidelity (e.g., use of fidelity forms). Most clinicians reported engaging in reflective supervision and are satisfied with their experiences. Participants in all roles expressed a need for empathy for parents with SUD, while also recognizing its impacts on the ability to receive clinician services. Also across roles was a discussion of parents’ readiness for change and how that – as well as their general level of participation – frequently dictates “success” as it relates to the parent-child relationship. Some clinicians felt there was a lack of a unified trauma-lens across team member roles and felt pressure to be the one to bring up “the elephant in the room” to the rest of the team.

General challenges aligning therapeutic goal timelines with permanency goal timelines were discussed. The secondary data analysis revealed few differences, though did find that families receiving CPP had longer times to case closure. While it’s possible CPP is the reason for the extended timeline, it’s also possible that parents need more time to work on SUD issues or readiness for change before meaningfully engaging in therapeutic work. Still, other clinicians and care team members shared that some families may just not be a match for ECC. Similar to our first evaluation, we found judicial support to be a key component of ECC – for both parents and professionals. Some tensions between roles were inconsistently noted, though relationships with attorneys appear to be the most strained. The parent-caregiver relationship was noted as very important, but could be challenging, particularly if the caregiver and parent have history. In terms of COVID-19, both professionals and families were impacted, though families more consistently reported negative aspects. While professionals saw some silver linings (e.g., able to reach more families through virtual means), parents didn’t always feel like they were getting the full ECC support experience. Moreover, many of the challenges the parents faced pre-pandemic have been exacerbated during COVID.

services. OSCA should explore the potential of including a standardized readiness for change assessment at the outset of services, the results of which could be shared with all team members. •

Develop policies and procedures regarding the incorporation of therapists’ professional expertise. Having policies and procedures in place for therapists to clearly articulate their recommended treatment plan or related adjustments to the ECC team could promote case transparency and establish more clarity around the role of the therapeutic provider.

•

Re-evaluate compensation practices for clinicians. While not a uniform concern, several clinicians expressed a lack of financial support for clinicians (e.g., non-billable hours for non-therapeutic time spent on ECC activities). While not a focus of this evaluation, this emergent issue merits further exploration.

•

Improve team member orientation to ECC. Clinicians expressed a desire for improved orientation to the ECC team and foundational principles, with an emphasis on role clarity and the use of a trauma-informed approach. Given the high prevalence of substance use and need for relapse support, the evaluation team suggests onboarding for all team members include content on how substance-related issues impact families and their progress with ECC.

•

Explore expansion of reflective supervision to nonclinician team members. Given that professional team members contribute to families’ therapeutic networks, the OSCA should explore the possibility of arranging reflective supervision for them.

•

Implement increased supports for caregivers. While caregivers in the present sample spoke highly of their relationships with professional team members, they reported more challenges or frustrations when engaging with parents. ECCs should further explore with caregivers what additional formal supports would be helpful toward fulfilling their role as part of the ECC team.

The present evaluation findings broadly indicate clinician fidelity to the general processes of COS-P and CPP, though future evaluators should consider more nuanced examinations of fidelity that still maintains client confidentiality.

Recommendations Despite these limitations, the evaluation team developed several recommendations for OSCA, both specific to parenting-centered therapeutic provision in ECC, as well as for Florida’s ECCs overall: •

Allow the use of multiple therapeutic modalities within ECC. The ability to remain flexible, while maintaining a focus on the parent-child relationship, was considered a main tenet of therapeutic services with ECC-involved families.

•

Standardize system-wide data collection. A primary barrier to evaluating therapeutic fidelity is the lack of uniform data collection or entry from clinicians. At minimum, objective data should be entered for COS-P and CPP as the primary reported modalities to improve future analyses related to family outcomes.

•

Clarify processes regarding client eligibility for services. Clinicians shared that not all ECC-involved families are prepared to engage in intensive parenting therapeutic

In addition to the above recommendations, the evaluation team suggests future evaluations incorporate assessment of 1) variation in therapeutic services related to both processes and outcomes, 2) challenges in CPP implementation, specifically as it pertains to working with multiple family members in a single session, 3) how the COVID-19 pandemic impacts therapeutic services, and 4) the potential significance of clinicians having a professional background in child welfare.

References 1

Early Childhood Court Programs, Fla. Stat. § 39.01304 (2020).

2 Office of the State Courts Administrator [OSCA]. (n.d.). Early childhood courts. Florida Courts. Retrieved May 4, 2021 from https://www.flcourts.org/Resources-Services/Court-Improvement/Problem-Solving-Courts/Early-Childhood-Courts 3 ZERO TO THREE [ZTT]. (2020). The Safe Babies Court TeamTM approach. Retrieved May 4, 2021 from https://www.zerotothree.org/resourc es/services/the-safe-babies-court-team-approach 4 Supreme Court of the State of Florida. (2019). Florida early childhood court best practice standards. https://www.flcourts.org/content/down load/682604/file/Early_Childhood_Court_Best_Practice_Standards.pdf 5

ZERO TO THREE [ZTT]. (2017). Final evaluation report of the quality improvement center for research-based infant-toddler court teams. Retrieved May 4, 2021 https://www.zerotothree.org/resources/2181-safe-babies-court-team-trauma-informed-care-that-s-changing lives 6 ZERO TO THREE [ZTT]. (2021). HRSA infant-toddler court program sites. Retrieved May 4, 2021 https://www.zerotothree.org/resources/3115 hrsa-infant-toddler-court-program-sites 7 Office of the State Courts Administrator [OSCA]. (2020). Florida’s early childhood court: Data analysis report. Retrieved May 31, 2021 from: https://www.flcourts.org/content/download/732711/file/ECC%20December%202020%20Data%20Analysis_Final.pdf

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McCombs-Thornton, K. L., & Foster, E. M. (2012). The effect of the ZERO TO THREE Court Teams initiative on types of exits from the foster care system—A competing risks analysis. Children and Youth Services Review, 34(1), 169–178. https://doi.org/10.1016/j. childyouth.2011.09.013 9 Shea, K., & Graham, M. (2018). Early Childhood Courts: The opportunity to respond to children and families affected by the opioid crisis. ZERO TO THREE, 38(5), 39–47. 10

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Questions & Comments: FOR MORE INFORMATION, CONTACT:

Lisa Magruder, Ph.D., MSW

Program Director of Science & Research Florida Institute for Child Welfare lmagruder@fsu.edu

Jennifer Marshall, Ph.D., MPH Associate Professor University of South Florida jm@usf.edu

Florida Institute for Child Welfare

2139 Maryland circle, Suite 1100, Tallahassee, FL 32303 FICW.FSU.EDU

850-644-7201

FICW@FSU.EDU

@FSUChildWelfare

2020-2021 Early Childhood Court Evaluation - Executive Summary